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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Untitled Document</title>
</head>

<body>
<select name="D">
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select name="M">
<option value="jan">jan</option>
<option value="feb">feb</option>
<option value="mar">mar</option>
<option value="apr">apr</option>
<option value="may">may</option>
<option value="jun">jun</option>
<option value="jul">jul</option>
<option value="aug">aug</option>
<option value="sep">sep</option>
<option value="oct">oct</option>
<option value="nov">nov</option>
<option value="dec">dec</option>
</select>
<select name="Y">
<?php
$yr=date("Y");
$i=$yr-100;
while($i<($yr-15)){?>
<option value="<?php echo $i;?>"><?php echo $i;?></option>
<?php $i++;} ?>
</select>
</body>
</html>
